Ob-Gyn Coding Alert

Question: My physician performed a laparoscopic paravaginal repair for cystocele. He worked with a urologist who performed a transvaginal tape procedure (TVT). How should I code for the paravaginal repair? Michigan Subscriber Answer: There is no dedicated code for a laparoscopically performed paravaginal defect repair. You should report the unlisted-procedure code 49329 (Unlisted laparoscopy procedure, abdomen, peritoneum and omentum). From a surgical work standpoint, a laparoscopic paravaginal is very similar to a laparo-scopic Burch procedure. However, there is additional dissection and several more sutures placed along the mid- and upper-vaginal segment as opposed to being limited to the distal vagina in the periurethral region.

In brief, a total of four sutures two on each side are placed for the laparo-scopic Burch at the level of the bladder neck, and the sutures are anchored at Cooper's ligament. The laparoscopic paravaginal repair includes the same four sutures placed in the same vaginal tissue, but they are then anchored to the obturator internus fascia. There are also four to five sutures added along and into the mid upper vaginal region. It is for these reasons that some surgeons we consulted have stated they report the laparoscopic Burch code 51990 (Laparoscopy, surgical; urethral suspension for stress incontinence) with modifier -22 (Unusual procedural services).

Remember, however, that the introduction to CPT 2002 clarifies that the coder should not select a code that is simply "close" to the service that was provided. It stresses that if no accurate code for the procedure exists, the unlisted-procedure code is the only coding choice. Some payers, however, will not accept unlisted-procedure codes and request that you pick the "closest" code. Always check with your payer to be sure. Reader Questions and You Be the Coder were reviewed by Melanie Witt, RN, CPC, MA, an ob/gyn coding expert based in Fredericksburg, Va.